Article type
Abstract
Background: Disease-management programmes (DMPs) have been established to improve care for chronically ill patients in Germany since 2002. The German Institute for Quality and Efficiency in Health Care (IQWiG) is regularly commissioned to prepare evidence-based guideline synopses. On the basis of systematic searches for national and international evidence-based guidelines, either a need to update existing DMPs is specified or relevant recommendations for new DMPs are identified.
Objectives: To present the methodological approach for the production of guideline synopses on specific chronic diseases using the example of the guideline synopsis for a DMP 'coronary heart disease'.
Methods:After systematically searching guideline databases and websites of guideline providers, guidelines are selected following predefined inclusion and exclusion criteria. The search period covers a maximum of 5 years. DMP-relevant recommendations are extracted from the guidelines and summarised into key statements. Under consideration of the Grade of Recommendation (GoR) awarded by the guideline authors, it is evaluated which key statements could lead to a DMP update. As the guideline developers use different classification systems for the GoR, a uniform categorisation for the GoR is required to be able to compare recommendations.
Results: On the basis of the summarised key statements it is evaluated whether the corresponding recommendations are consistent with or contradict each other. It is also evaluated whether the key statements are already included in the existing DMPs and, if so, are consistent with or contradict the key statements generated from the guidelines. IQWiG subsequently provides its evaluation on whether a DMP should be updated or not.
Conclusions: IQWiG’s guideline synopses form a statutory basis for the production and update of DMPs in Germany; correspondingly, these products are politically relevant. This requires a systematic and comprehensible methodological approach, but also a critical discussion of the limits of such an approach.
Objectives: To present the methodological approach for the production of guideline synopses on specific chronic diseases using the example of the guideline synopsis for a DMP 'coronary heart disease'.
Methods:After systematically searching guideline databases and websites of guideline providers, guidelines are selected following predefined inclusion and exclusion criteria. The search period covers a maximum of 5 years. DMP-relevant recommendations are extracted from the guidelines and summarised into key statements. Under consideration of the Grade of Recommendation (GoR) awarded by the guideline authors, it is evaluated which key statements could lead to a DMP update. As the guideline developers use different classification systems for the GoR, a uniform categorisation for the GoR is required to be able to compare recommendations.
Results: On the basis of the summarised key statements it is evaluated whether the corresponding recommendations are consistent with or contradict each other. It is also evaluated whether the key statements are already included in the existing DMPs and, if so, are consistent with or contradict the key statements generated from the guidelines. IQWiG subsequently provides its evaluation on whether a DMP should be updated or not.
Conclusions: IQWiG’s guideline synopses form a statutory basis for the production and update of DMPs in Germany; correspondingly, these products are politically relevant. This requires a systematic and comprehensible methodological approach, but also a critical discussion of the limits of such an approach.